364
THE INDIAN MEDICAL GAZETTE.
gt Jiiipi of Hospital fipctiti}. A CASE OF EPILEPTIFORM FITS?
HEMIPLEGIA.
RECOVERY.
By Assistant Sukgeon T. M.
SHAW,
l.m.s.
24 years, mother of three two years old. During her last pregnancy mild fits commenced, marked by temporary vacancy of mind and uneasiness. They could hardly be noticed by others, although the patient declared that she was unwell occasionally. The first severe convulsive fit was noticed 011 the third day of delivery. Fits were in the beginning regarded as hysterical or A LADY,
N?, aged
children, the youngest
hystero-epileptic.
In the course of the last two years, fits recurred in the early part at intervals, and were transient in their duration. Latterly they have advanced in frequency and duration. Each fit is preceded by a forewarning, and the patient never fell down unconscious as in the ordinary epileptic seizures. Every fit was attended by convulsions of the face and left limbs, together The tongue with temporary unconsciousness. was saved by the introduction of a cork beThere never was foaming at tween the teeth. the mouth. Every fit was followed by numbness of the left hand. On inquiry into the family history, her grandmother is said to have suffered from insanity, and her sister suffered from purely hysterical fits. Her husband declares that there is some relation between the supervention of fits and He says he has noticed that the menstrual flow. just before or after mostly appear during, they Her children are the appearance of menses. all healthy, though rather weak and lean in appearance. 12tli November.?From midnight of 10th November a series of fits commenced recurring at short intervals in successive attacks. Hours intervened at first, but the intervals decreased and fits now (12th November) re-appeared every few minutes. There were 95 fits up to midnight of 11th November and 115 fits in tlie next The left side of the body is paralys24 hours. ed. The left arm was the first to lose its power on the 11th, and the leg followed its example 011 the next day. In the beginning of this illness there was distortion of the left hand and its fingers with considerable swelling. Both the left limbs though powerless are painful to touch. The left hand is blistered 011 its dorsum; eyes were
injected.
At 1 a.m., 12th November, the patient was placed under my care. She was then hemiplegic with a pulse beating onehundred times per minute and fits recui ring frequently about 5 or 6 times in an hour. During a fit, as observed by me, the left
[Deo.
1890.
limbs and face were violently convulsed, and she was unconscious. The face was drawn to the left side, and distorted hideously just as in convulsions; the eyeballs were at first fixed, and then drawn to the left. The head was also thrown towards left side. Patient was restless and tossed about in the intervals when she was only semi-conscious. Her speech was thick and sometimes unintelligible. Each fit lasted for a minute or two. She was treated by her previous medical attendant with chloral hydrate and potass and bromide. I-30 a.m.?Thirty grains of sulphonal were given. As fits continued unabated in frequency choloroform was inhaled from 2-30 to 4-30 a.m. for about two hours, during which H oz. of chloroform Avas consumed without exercising If anything, any material influence on fits. the intervals were a few minutes longer, but their severity was much the same. 5 a.m.?Temperature 99? P. Pulse 100. grain of morphia was injected hypodermically. Cold applied to head and the following mixture
puerperal
ordered:?
was
Potass, bromid.
R
...
Do. iodid. Chloral hydrate
... ...
Liq. hydrarg. perclil. Aqua) anisi 3
doses,
one
...
...
grs. 30. grs. 45. grs. 15. 3ii. oz. iii.
every three hours.
7 A.M.?Her husband desired to hold a consultation, and an eminent physician was sent for by wire from Bombay. trains of calomel were administered. 5 D 11 a.m.?Since the injection of morphia, patient is drowsy, but there is no abatement in the frequency or severity of fits. v
II-30 12-30
100? F. Pulse 100?. upon the nape of neck.
a.m.?Temperature
Mustard plaster applied a
minutes.
questions.
M.?Fits recur She sat up for a
Pulse 112?.
every 15 to 20 and answered
while,
5 P.M.?Cold
application to head continued. Temples were bled by cupping. Mustard reapplied on the nape. Morning mixture is repeated. Fits return at longer intervals. Temperature 102?. She is took food just
little more conscious and Answers rationally. 8 p.m. Temperature 101?. Pulse 120?. Fits return at 20 to 30 minutes intervals, but her She is pulse is getting weak and frequent. about. violent during intervals and throws herself 10 P.M.?One'dose of mixture with 40 grs. of now
a
now.
?
sulphonal given, mil,
less
but half
2 A.M.?Did not
frequent.
spat out. sleep. Is
Intervals
are an
#
raving. Fits hour longer in
their duration. Difficulty in administering medicines. 6-30 a.m.?She asked for tea, sat up and in
her
own
hand.
it, holding the cup Conversed quite rationally, recognizes peisons,
drank
CASE OF HYSTERICAL EPILEPSY.
Dec. 1890.]
and she is conscious. Pulse and temperat ure are Mixture and cold to head are continued. down. 11 A. m.?Took her food and medicine. Washed her face. Had only three fits since 5 A.M. Urine passed in bed. No motion during the last 30 hours. She goes off occasionally, and wanders and tosses about. 2 p.m.?She is sleepy and drowsy. Roused by applying mustard on the neck and calves. When well roused she talks rationally, otherwise she is somewhat incoherent. Left eye is normal, right one is congested. Temperature 99?. Pulse 110. 8 P.M. No fit since 12 a.m. Pulse 110?. Temperature 99"8?. Takes her food and medicine, and answers questions rationally. 14th, 2 a. m.?The medical consultant from Potassium bromide and Bombay arrived. iodide of potass mixture omitted. Digitalis and ?
sulphonal fgrs. 25) administered. 7
a.
M.?Pulse 120.
ature 99*6?.
Is
getting
Sulphonal
Very and
low.
weak.
Temper-
digitalis repeated.
extremely weak. Swallows no medicine nor food. .Enema of soap administered. Both eyes congested, but the right one more so. 6 p.m.?Is in a moribund condition. Tem120?. 100?. Pulse Small and weak. Pupils perature normal in size, but sluggish in responding to light. She is occasionally restless and throws herself about. Conjunctiva insensible, slight lividity of hands and face, swallows with difficulty. Digitalis and sulphuric ether were injected under skin. Six leechesapplied to each temple, mustard plaster upon neck, mercurial ointment embrocation behind ears. 10 a.m.?Is
6 a.m.
15th,
?
116:?
Pulse
Temperature 100'4?.
R
Potass, iodic!.
...
Liq. hydrarg. perclit.
,Trg
...
...
ms.
y
xv.
Dft. to be given every three hours with milk, mercurial embrocation continued.
10 a.m. Had three scanty semi-liquid motions. Knees, feet, and hands are cold. Pulse ?
faintly perceptible.
air is
Respirations
26.
warm.
P.M.
less red. She is so far conscious as to medicine from food, and rejects the former. On touching the left hand she complains Jactitations of right limb persist. of pain. Mercurial inunction continued. Digitalis, liq. hydrarg, perchlor, internally, iodide of potass, occasionally. Cold application to head. 2 P.M. Eyes suffused and face flushed. Temperature lOO^0. Pulse 116. She takes congee or soup every two hours and rejects medicines. 17th, 7 a.m.?Temperature 97*4?. Pulse 98. There is slight return of consciousness and she asks for tea. Digitalis, liq. hydrarg. perchlor. and Swallows her potass, iodid. are continued.
junctiva
recognise
?
liquid'food. 4
p.m.?Bed
then,
with digitalis and hot. Temperature 103?. Pulse 130, frequent and thready. Jactitations of right limb continues. Ice-bag over head. Digitalis and mercury internally. 8 p.m.?Temperature 102?. Pulse febrile, Patient lies in a semi-colarger, stronger, 120. swallows but her liquid food in condition, matose the shape of congee and soup administered every Bowels few hours. Urine still passed in bed. not moved. 1Gth, 3 a.m.?Temperature 100?. Pulse 112?. Some spasmodic involuntary movements of the affected limbs (left) are noticeable. Conjunctivae 8 a.m.?Temperature 99*4?. Pulse
108.
Con-
on
sacrum, moans now
and.
answers
istered. 99?. Pulse 82. Is Her consciousness is now complete. She tries to grasp with the left hand. The left leg also moves though not yet readily. Her voice and speech are not quite clear. Congestion of eyes is getting less, and fever keeps down. Progress is satisfactory and hopeful. 19^, 7 a.m.?Slept well throughout the whole nia-ht. Takes her food and medicine Temperature 98 8?. Pulse 82. Bowels moved once. She turns on her side by herself. 8
p.m.?Temperature
sleeping quietly.
regularly? ft
Tinct. digitalis Spt. ammonias aromat. Potass, bromid. Potass, iodid. ...
Aqute
?
continue congested.
sore
rather coherently, and raves occasionally. Urine passed in bed. Menses have appeared. Congestion of eyes is less. Bowels costive. 2 grs. of calomel given. Ice over head. 18^/i, 1 a.m.?Temperature 98-8?. Pulse 88. Application of ice discontinued. Other treatment continued. 12 a.m.?Had two motions. Congestion of Coneyes less. Temperature 98"8?. Pulse 88. sciousness is to a great extent restored. 4-30 p.m.?Had two more motions" with straining. 15 grs. of aromatic powder of chalk with a little sal volatile aud brandy were admin-
Expired
Congee given liquor hydrargyri. Body 2
365
...
...
???
???
???
???
...
nis*
??? ...
30.
5i.
???
grs.
xx.
grs. xv, oz-
3 doses.
She is able to move left hand and limited extent. Complains of headache. Temperature 101'5?. Pulse 96. Ice-bag to be applied upon the head, and two doses of tincture of aconite administered. 20th, 1 a.m.?Is restless, 25 grs. of sulphonal given. 7
p.m.
leg
to
7 Jial.
a.m.?Slept
a
well after the dose of 98?. Pulse 75.
Temperature
continued.
10 p.m.?She wise
Had grs.
raves
gives rational one
occasionally, but otherTemperature 98'4?. Ice-bag upon head. 30
answers.
free motion.
sulphonal given.
sulphoMixture
48
366
THE INDIAN MEDICAL GAZETTE.
21s*, 4 A.M.?Temperature 97"8?. Pulse 68. Body rather cold, windows shut up, warm covering, and hot water-bottles applied, and a dose of stimulant mixture given. 11 A.M.? Had a free motion. Temperature 99*6?.
She lies in
Pulse 80?.
half drowsy but answers are rational. She is fed with soup and congee every 4 hours during day and every 6 hours during night; conjunctiva is almost clear of redness. She desires to have a bath. Body was therefore sponged with warm water. Power and sensation in the left limbs progressing for the better. There are slight variations in temperature and pulse from morning to evening. In the evening temperature is between 99? to 100? and whenever temperature rises, ice-bag is kept upon the head. Mixture and mercurial ointment are continAbout 30 grs. of the ointment are apued. plied behind the ears or in the armpits. In the course of a week 5 iv of blue ointment were used without any signs of salivation. Patient requires sulphonal occasionally to procure sound
state and wanders
a
occasionally,
sleep.
22nd, 9 a.m.?Temperature 98*4?. Pulse 75. She can be roused to her senses easily, but when undisturbed she relapses into drowsiness. She is given 4 grs. of quinine daily in the morning. She sat up, sent 2 P.M.?Had a free motion. for her children, and had a chat with them for the first time since her present illness. 23rd, 7 a.m.?Menstrual discharge is 011 and has appeared since a week. Temperature 99?. Pulse 80. Tine, digitalis R 3p. Potass, bromid. 5p. ...
...
...
...
Potass, iodid.
...
...
Quinine sulpbat.
...
...
Syrup Aquas
... ...
... ...
...
...
... ...
... ...
...
grs. x.
grs. x. 3 vi. oz. ii.
3 doses.
Liniment of belladonna and ammonia for embrocation of paralysed limbs. 10 p.m.?Temperature 100?. Pulse 80. Talks somewhat incoherently. She took only one dose of mixture. Takes her usual amount of food. 24th, 8 a.m.?Bowels costive and had three grains of calomel given to her. Temperattire Pulse 88. 98'8?. Paralysed hand was very tender before, but is not sensitive now. Had three motions in the course of the day. 25th, 7 a.m.?Occasionally she complains of excessive pain in the paralysed limbs. Belladonna liniment for embrocation. Mixture and mercurial ointment continued, Temperature 98?. Pulse 82. 2ith,8 a.m.?Temperature 9S'2?. Pulse 82. Takes her food, sits up without assistance, and plays at cards. Has more power over the para-
lysed limbs. 28*//,
walk
7-30 a.m.?She stood up, but could not of pain iu the calf at the seat
011 accouut
of Is
[Dec. 1890,
of aether sulphuric, a fortnight backprogressing satisfactorily. 30tli, 8 a.m.?Is in good spirits, no headache, no redness of conjunctiva, she walks a few paces. Is getting more power in the limbs day by day,
injection
grasp of hand is firm. No fit since the 13th instant. Treatment was then continued with necessary
changes in prescription, and patient made steady progress, and could in a short period take walks, a mile or more long. There was no recurrence
of fit for about 2 months?a
period
which had never intervened since she first began to have fits. Since then she is again subject to fits at intervals of a few weeks. Of the paralysis a trace is left both in the hand and in the le
THE INDIAN MEDICAL GAZETTE.
gt Jiiipi of Hospital fipctiti}. A CASE OF EPILEPTIFORM FITS?
HEMIPLEGIA.
RECOVERY.
By Assistant Sukgeon T. M.
SHAW,
l.m.s.
24 years, mother of three two years old. During her last pregnancy mild fits commenced, marked by temporary vacancy of mind and uneasiness. They could hardly be noticed by others, although the patient declared that she was unwell occasionally. The first severe convulsive fit was noticed 011 the third day of delivery. Fits were in the beginning regarded as hysterical or A LADY,
N?, aged
children, the youngest
hystero-epileptic.
In the course of the last two years, fits recurred in the early part at intervals, and were transient in their duration. Latterly they have advanced in frequency and duration. Each fit is preceded by a forewarning, and the patient never fell down unconscious as in the ordinary epileptic seizures. Every fit was attended by convulsions of the face and left limbs, together The tongue with temporary unconsciousness. was saved by the introduction of a cork beThere never was foaming at tween the teeth. the mouth. Every fit was followed by numbness of the left hand. On inquiry into the family history, her grandmother is said to have suffered from insanity, and her sister suffered from purely hysterical fits. Her husband declares that there is some relation between the supervention of fits and He says he has noticed that the menstrual flow. just before or after mostly appear during, they Her children are the appearance of menses. all healthy, though rather weak and lean in appearance. 12tli November.?From midnight of 10th November a series of fits commenced recurring at short intervals in successive attacks. Hours intervened at first, but the intervals decreased and fits now (12th November) re-appeared every few minutes. There were 95 fits up to midnight of 11th November and 115 fits in tlie next The left side of the body is paralys24 hours. ed. The left arm was the first to lose its power on the 11th, and the leg followed its example 011 the next day. In the beginning of this illness there was distortion of the left hand and its fingers with considerable swelling. Both the left limbs though powerless are painful to touch. The left hand is blistered 011 its dorsum; eyes were
injected.
At 1 a.m., 12th November, the patient was placed under my care. She was then hemiplegic with a pulse beating onehundred times per minute and fits recui ring frequently about 5 or 6 times in an hour. During a fit, as observed by me, the left
[Deo.
1890.
limbs and face were violently convulsed, and she was unconscious. The face was drawn to the left side, and distorted hideously just as in convulsions; the eyeballs were at first fixed, and then drawn to the left. The head was also thrown towards left side. Patient was restless and tossed about in the intervals when she was only semi-conscious. Her speech was thick and sometimes unintelligible. Each fit lasted for a minute or two. She was treated by her previous medical attendant with chloral hydrate and potass and bromide. I-30 a.m.?Thirty grains of sulphonal were given. As fits continued unabated in frequency choloroform was inhaled from 2-30 to 4-30 a.m. for about two hours, during which H oz. of chloroform Avas consumed without exercising If anything, any material influence on fits. the intervals were a few minutes longer, but their severity was much the same. 5 a.m.?Temperature 99? P. Pulse 100. grain of morphia was injected hypodermically. Cold applied to head and the following mixture
puerperal
ordered:?
was
Potass, bromid.
R
...
Do. iodid. Chloral hydrate
... ...
Liq. hydrarg. perclil. Aqua) anisi 3
doses,
one
...
...
grs. 30. grs. 45. grs. 15. 3ii. oz. iii.
every three hours.
7 A.M.?Her husband desired to hold a consultation, and an eminent physician was sent for by wire from Bombay. trains of calomel were administered. 5 D 11 a.m.?Since the injection of morphia, patient is drowsy, but there is no abatement in the frequency or severity of fits. v
II-30 12-30
100? F. Pulse 100?. upon the nape of neck.
a.m.?Temperature
Mustard plaster applied a
minutes.
questions.
M.?Fits recur She sat up for a
Pulse 112?.
every 15 to 20 and answered
while,
5 P.M.?Cold
application to head continued. Temples were bled by cupping. Mustard reapplied on the nape. Morning mixture is repeated. Fits return at longer intervals. Temperature 102?. She is took food just
little more conscious and Answers rationally. 8 p.m. Temperature 101?. Pulse 120?. Fits return at 20 to 30 minutes intervals, but her She is pulse is getting weak and frequent. about. violent during intervals and throws herself 10 P.M.?One'dose of mixture with 40 grs. of now
a
now.
?
sulphonal given, mil,
less
but half
2 A.M.?Did not
frequent.
spat out. sleep. Is
Intervals
are an
#
raving. Fits hour longer in
their duration. Difficulty in administering medicines. 6-30 a.m.?She asked for tea, sat up and in
her
own
hand.
it, holding the cup Conversed quite rationally, recognizes peisons,
drank
CASE OF HYSTERICAL EPILEPSY.
Dec. 1890.]
and she is conscious. Pulse and temperat ure are Mixture and cold to head are continued. down. 11 A. m.?Took her food and medicine. Washed her face. Had only three fits since 5 A.M. Urine passed in bed. No motion during the last 30 hours. She goes off occasionally, and wanders and tosses about. 2 p.m.?She is sleepy and drowsy. Roused by applying mustard on the neck and calves. When well roused she talks rationally, otherwise she is somewhat incoherent. Left eye is normal, right one is congested. Temperature 99?. Pulse 110. 8 P.M. No fit since 12 a.m. Pulse 110?. Temperature 99"8?. Takes her food and medicine, and answers questions rationally. 14th, 2 a. m.?The medical consultant from Potassium bromide and Bombay arrived. iodide of potass mixture omitted. Digitalis and ?
sulphonal fgrs. 25) administered. 7
a.
M.?Pulse 120.
ature 99*6?.
Is
getting
Sulphonal
Very and
low.
weak.
Temper-
digitalis repeated.
extremely weak. Swallows no medicine nor food. .Enema of soap administered. Both eyes congested, but the right one more so. 6 p.m.?Is in a moribund condition. Tem120?. 100?. Pulse Small and weak. Pupils perature normal in size, but sluggish in responding to light. She is occasionally restless and throws herself about. Conjunctiva insensible, slight lividity of hands and face, swallows with difficulty. Digitalis and sulphuric ether were injected under skin. Six leechesapplied to each temple, mustard plaster upon neck, mercurial ointment embrocation behind ears. 10 a.m.?Is
6 a.m.
15th,
?
116:?
Pulse
Temperature 100'4?.
R
Potass, iodic!.
...
Liq. hydrarg. perclit.
,Trg
...
...
ms.
y
xv.
Dft. to be given every three hours with milk, mercurial embrocation continued.
10 a.m. Had three scanty semi-liquid motions. Knees, feet, and hands are cold. Pulse ?
faintly perceptible.
air is
Respirations
26.
warm.
P.M.
less red. She is so far conscious as to medicine from food, and rejects the former. On touching the left hand she complains Jactitations of right limb persist. of pain. Mercurial inunction continued. Digitalis, liq. hydrarg, perchlor, internally, iodide of potass, occasionally. Cold application to head. 2 P.M. Eyes suffused and face flushed. Temperature lOO^0. Pulse 116. She takes congee or soup every two hours and rejects medicines. 17th, 7 a.m.?Temperature 97*4?. Pulse 98. There is slight return of consciousness and she asks for tea. Digitalis, liq. hydrarg. perchlor. and Swallows her potass, iodid. are continued.
junctiva
recognise
?
liquid'food. 4
p.m.?Bed
then,
with digitalis and hot. Temperature 103?. Pulse 130, frequent and thready. Jactitations of right limb continues. Ice-bag over head. Digitalis and mercury internally. 8 p.m.?Temperature 102?. Pulse febrile, Patient lies in a semi-colarger, stronger, 120. swallows but her liquid food in condition, matose the shape of congee and soup administered every Bowels few hours. Urine still passed in bed. not moved. 1Gth, 3 a.m.?Temperature 100?. Pulse 112?. Some spasmodic involuntary movements of the affected limbs (left) are noticeable. Conjunctivae 8 a.m.?Temperature 99*4?. Pulse
108.
Con-
on
sacrum, moans now
and.
answers
istered. 99?. Pulse 82. Is Her consciousness is now complete. She tries to grasp with the left hand. The left leg also moves though not yet readily. Her voice and speech are not quite clear. Congestion of eyes is getting less, and fever keeps down. Progress is satisfactory and hopeful. 19^, 7 a.m.?Slept well throughout the whole nia-ht. Takes her food and medicine Temperature 98 8?. Pulse 82. Bowels moved once. She turns on her side by herself. 8
p.m.?Temperature
sleeping quietly.
regularly? ft
Tinct. digitalis Spt. ammonias aromat. Potass, bromid. Potass, iodid. ...
Aqute
?
continue congested.
sore
rather coherently, and raves occasionally. Urine passed in bed. Menses have appeared. Congestion of eyes is less. Bowels costive. 2 grs. of calomel given. Ice over head. 18^/i, 1 a.m.?Temperature 98-8?. Pulse 88. Application of ice discontinued. Other treatment continued. 12 a.m.?Had two motions. Congestion of Coneyes less. Temperature 98"8?. Pulse 88. sciousness is to a great extent restored. 4-30 p.m.?Had two more motions" with straining. 15 grs. of aromatic powder of chalk with a little sal volatile aud brandy were admin-
Expired
Congee given liquor hydrargyri. Body 2
365
...
...
???
???
???
???
...
nis*
??? ...
30.
5i.
???
grs.
xx.
grs. xv, oz-
3 doses.
She is able to move left hand and limited extent. Complains of headache. Temperature 101'5?. Pulse 96. Ice-bag to be applied upon the head, and two doses of tincture of aconite administered. 20th, 1 a.m.?Is restless, 25 grs. of sulphonal given. 7
p.m.
leg
to
7 Jial.
a.m.?Slept
a
well after the dose of 98?. Pulse 75.
Temperature
continued.
10 p.m.?She wise
Had grs.
raves
gives rational one
occasionally, but otherTemperature 98'4?. Ice-bag upon head. 30
answers.
free motion.
sulphonal given.
sulphoMixture
48
366
THE INDIAN MEDICAL GAZETTE.
21s*, 4 A.M.?Temperature 97"8?. Pulse 68. Body rather cold, windows shut up, warm covering, and hot water-bottles applied, and a dose of stimulant mixture given. 11 A.M.? Had a free motion. Temperature 99*6?.
She lies in
Pulse 80?.
half drowsy but answers are rational. She is fed with soup and congee every 4 hours during day and every 6 hours during night; conjunctiva is almost clear of redness. She desires to have a bath. Body was therefore sponged with warm water. Power and sensation in the left limbs progressing for the better. There are slight variations in temperature and pulse from morning to evening. In the evening temperature is between 99? to 100? and whenever temperature rises, ice-bag is kept upon the head. Mixture and mercurial ointment are continAbout 30 grs. of the ointment are apued. plied behind the ears or in the armpits. In the course of a week 5 iv of blue ointment were used without any signs of salivation. Patient requires sulphonal occasionally to procure sound
state and wanders
a
occasionally,
sleep.
22nd, 9 a.m.?Temperature 98*4?. Pulse 75. She can be roused to her senses easily, but when undisturbed she relapses into drowsiness. She is given 4 grs. of quinine daily in the morning. She sat up, sent 2 P.M.?Had a free motion. for her children, and had a chat with them for the first time since her present illness. 23rd, 7 a.m.?Menstrual discharge is 011 and has appeared since a week. Temperature 99?. Pulse 80. Tine, digitalis R 3p. Potass, bromid. 5p. ...
...
...
...
Potass, iodid.
...
...
Quinine sulpbat.
...
...
Syrup Aquas
... ...
... ...
...
...
... ...
... ...
...
grs. x.
grs. x. 3 vi. oz. ii.
3 doses.
Liniment of belladonna and ammonia for embrocation of paralysed limbs. 10 p.m.?Temperature 100?. Pulse 80. Talks somewhat incoherently. She took only one dose of mixture. Takes her usual amount of food. 24th, 8 a.m.?Bowels costive and had three grains of calomel given to her. Temperattire Pulse 88. 98'8?. Paralysed hand was very tender before, but is not sensitive now. Had three motions in the course of the day. 25th, 7 a.m.?Occasionally she complains of excessive pain in the paralysed limbs. Belladonna liniment for embrocation. Mixture and mercurial ointment continued, Temperature 98?. Pulse 82. 2ith,8 a.m.?Temperature 9S'2?. Pulse 82. Takes her food, sits up without assistance, and plays at cards. Has more power over the para-
lysed limbs. 28*//,
walk
7-30 a.m.?She stood up, but could not of pain iu the calf at the seat
011 accouut
of Is
[Dec. 1890,
of aether sulphuric, a fortnight backprogressing satisfactorily. 30tli, 8 a.m.?Is in good spirits, no headache, no redness of conjunctiva, she walks a few paces. Is getting more power in the limbs day by day,
injection
grasp of hand is firm. No fit since the 13th instant. Treatment was then continued with necessary
changes in prescription, and patient made steady progress, and could in a short period take walks, a mile or more long. There was no recurrence
of fit for about 2 months?a
period
which had never intervened since she first began to have fits. Since then she is again subject to fits at intervals of a few weeks. Of the paralysis a trace is left both in the hand and in the le
